Abstract
BACKGROUND: Endometriomas may adversely affect fertility; however, the necessity of its surgical management is a controversial subject. The aim of this study was to compare the time to conception, mode of conception, and pregnancy outcomes between two groups of patients diagnosed with endometriomas: those managed conservatively and those who laparoscopic cystectomy. METHODS: This retrospective study included patients diagnosed with endometriomas who are seeking pregnancy. All patients who conceived were categorized into the following two groups: those who underwent surgical intervention for treating endometriomas and those who did not. Demographic data, time to conception (months), and pregnancy outcomes were recorded. RESULTS: A total of 5444 patients were screened, and data for 226 patients meeting the inclusion criteria were analyzed (80 in the surgical group and 146 in the nonsurgical group). Age and body mass index were comparable between the groups. Time to conception (months) was significantly different between the surgical and nonsurgical groups (24 [12-51] vs. 18 [6.5-36], p = 0.030). Further, the probability of conception over time was significantly higher in the nonsurgical group (p = 0.002). The live birth rate was 78.8% (n = 63) in the surgical group and 69.2% (n = 101) in the nonsurgical group, with no significant difference between the groups (p = 0.220). CONCLUSIONS: Endometrioma surgery was associated with a longer time to conception but had no effect on live birth rate or delivery outcome. Patient selection is critical and further investigation is needed to determine who will benefit from surgery.